gonorrhea

Definition

Gonorrhea is a highly contagious sexually transmitted disease that is caused by the bacterium Neisseria gonorrhoeae. The mucous membranes of the genital region may become inflamed without the development of any other symptoms. When symptoms do occur, they are different in men and women. In men, gonorrhea usually begins as an infection of the vessel that carries urine and sperm (urethra). In women, it will most likely infect the narrow part of the uterus (cervix). If untreated, gonorrhea can result in serious medical complications.

Description

Gonorrhea is commonly referred to as "the clap." The incidence of gonorrhea has steadily declined since the 1980s, largely due to increased public awareness campaigns and the risk of contracting other sexually transmitted diseases, such as AIDS. Still, current estimates range from 400,000 to as many as one million projected cases of gonorrhea in the United States each year. These estimates vary due to the private nature of the disease and the consequent underreporting that occurs. The majority of reported cases of gonorrhea come from public health clinics.

The disease affects people of all ages, races, and socioeconomic levels, but some individuals are more at-risk than others. Adolescents and young adults are the highest risk group, with more than 80% of the reported cases each year occurring in the 15–29 age group. Those individuals with multiple sexual partners and who use no barrier contraception, such as condoms, are most at-risk. Reported rates vary among racial and ethnic groups.

The risk factors for gonorrhea are not unlike those for all sexually transmitted diseases. Both men and women can become infected through a variety of sexual contact behaviors, including oral, anal, or vaginal inter-course. The disease is transmitted very efficiently. In fact, women run a 60–90% chance of contracting the disease after just one sexual encounter with an infected male. The disease can also be transmitted from an infected mother to her infant during delivery.

— Teresa G. Norris

A sexually transmitted disease caused by gonococcal bacteria that affects the mucous membrane chiefly of the genital and urinary tracts and is characterized by an acute purulent discharge and painful or difficult urination, though women often have no symptoms.

[Greek gonorrhoia, flow of seed (from the mistaken belief that the discharge contained semen) : gono-, gono- + -rhoia, -rrhea.]

A common sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae. Humans are the only natural hosts for N. gonorrhoeae, which directly infects the epithelium of the mucous membranes of the human genital tract, pharynx, rectum, or conjunctiva. Local epithelial cell destruction usually occurs, but the organisms may spread to adjacent organs or disseminate via the bloodstream. In women, local complications include inflammation of the uterine lining (endometritis), inflammation of the fallopian tube (salpingitis), inflammation of the abdominal wall (peritonitis), and inflammation of Bartholin's glands (bartholinitis); in men, periurethral abscess and inflammation of a duct connected to the testes (epididymitis). Systemic manifestations such as arthritis or dermatitis may develop, and rarely endocarditis or meningitis.

Women are disproportionately affected by the complications of gonorrhea. Acute pelvic inflammatory disease and salpingitis, the most serious complications of gonorrhea, result in ectopic pregnancy and infertility. Gonococcal infection during pregnancy may also predispose women to premature rupture of membranes, delivery in less than full term, and postpartum endometritis. During childbirth, the gonococcus may infect the conjunctiva of the infant and result in the infection ophthalmia neonatorum. This infection is a serious complication that remains common in less developed countries and can lead to permanent damage to the eye and blindness. See also Infertility; Reproductive system disorders.

Gonorrhea continues to be the most commonly reported communicable disease in the United States, although incidence has declined since 1984. Risk factors that may influence the probability of infection include number of sexual partners, lack of barrier contraceptives, and young age.

Gonorrhea is an infection spread by physical contact with the mucosal surfaces of an infected person, usually a sexual partner. The risk of infection depends on the anatomic site, the amount of substance containing bacteria, and the number of exposures. Variations in host susceptibility have not been well defined. In a small but significant proportion of infections, there are no symptoms. These individuals are important in the epidemiology of this disease because gonorrhea is usually spread by carriers who have no symptoms or have ignored symptoms.

Control of gonorrhea depends on early diagnosis, effective treatment, and identification of asymptomatic individuals. The last has been accomplished, in part, through screening programs. However, complete control has not been possible because of the emergence and spread of strains that are resistant to less-expensive antimicrobial treatments such as penicillin and tetracycline.

There is no evidence that infected individuals develop long-lasting immunity to reinfection, and vaccination is not available. Thus, the prevention of gonorrhea relies on behavior modification and risk reduction, use of appropriate screening and diagnostic tests, routine use of highly effective antibiotics, early identification and treatment of sexual partners of individuals with gonorrhea, and the appropriate use of barrier methods such as condoms.

An increasing proportion of infections are due to antibiotic-resistant strains of N. gonorrhoeae. Chromosomally mediated resistance to multiple antibiotics as well as plasmid-mediated resistance to beta-lactam antibiotics and tetracycline occurs in strains from both developed and developing countries. Nevertheless, infections can be effectively treated with third-generation cephalosporins (for example, ceftriaxone) or fluoroquinolones (for example, ciprofloxacin or ofloxacin). See also Sexually transmitted diseases.

A sexually transmitted disease of the genitourinary tract which is spread by direct contact with an infected person or fluids containing the infectious microorganism. The disease may also affect the conjunctiva, oral tissue, and other tissues and organ systems.

Definition

Gonorrhea is a highly contagious sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae bacterium. The genitourinary tract is the main system that is usually affected, but gonorrhea can also spread to the rectum, the throat, and the eyes. Left untreated, gonorrhea can spread through the bloodstream and infect the brain, heart valves, joints, and the reproductive system. Exposure to an infected mother during birth may cause permanent blindness in the newborn.

Description

Gonorrhea, commonly referred to as "the clap," is the most prevalent reportable disease in the United States. Adolescents and young adults are in the highest risk category, with more than 80% of gonorrhea cases affecting the 15–29 year-old age group. Individuals living in urban areas who have multiple sex partners have the highest risk of contracting the disease. Still, the incidence of gonorrhea has been steadily declining since 1987. This appears to be largely due to increased public awareness about the risks and prevention of contracting STDs such as herpes and HIV. However, in 2002, the Centers for Disease Control (CDC) expressed concern about rising rates of gonorrhea in certain urban areas during 1999 and 2000. About 650,000 new cases of gonorrhea occur every year in the United States. In particular, rates of gonorrhea were increasing substantially among men who have sex with men.

Causes & Symptoms

Gonorrhea is transmitted very efficiently. It can be spread by merely contacting the fluids of an infected person as well as by sexual contact. A person runs a 60–90% chance of contracting the disease after just one sexual encounter with an infected person. The symptoms usually begin between one day and two weeks after the initial encounter with the infection.

People who are infected with gonorrhea commonly experience increasingly frequent and painful urination, and the urethra may be painful and swollen. There may be a thick white, yellowish, or bloody discharge from the penis or vagina. Other symptoms may include nausea, vomiting, fever, chills, and pain during intercourse. In the case of oral infection, there may be a sore throat or pain during swallowing. An anal infection may cause rectal itching, rectal discharge, and a constant urge to move the bowels. Women who show symptoms of gonorrhea often have abdominal pain and breakthrough bleeding (spotting) between menstrual periods. However, many women who have gonorrhea do not experience any symptoms.

In infants and children, irritation, redness, swelling with a pus-like discharge, and possibly pain and a change in urination may point to a gonorrhea infection. The infection may be due to child abuse or exposure to infected materials. An in-depth history should be taken if gonorrhea is suspected.

Diagnosis

The initial diagnosis of gonorrhea will be based on symptoms, sexual history, and at-risk behavior. One laboratory test for diagnosis involves the observation of a gram-stained sample of the discharge under a microscope. In the gram stain test, the sample is dyed, washed with various solutions, and dyed with a different color. The final color identifies the class of bacteria present in the sample. The advantage of this test is that results can be obtained very quickly so that treatment can commence at the initial visit. In the vast majority of men, it is quite accurate; however, the test is not very accurate for women.

For all women and for men with a questionable gram-stain reading, samples of the discharge from the infected area can be collected and cultured. The sample is incubated for up to two days, which provides enough time for the bacteria to multiply and be accurately identified. This test is very accurate and specific for gonorrhea, but improper handling can lead to a false-negative reading. Other tests coming into favor include the ELISA (enzyme-linked immunosorbent assay) antibody test and DNA probe testing of genetic material from the discharge, both of which are quite accurate in identifying Neisseria gonorrhoeae.

Treatment

Although there is nothing that can totally replace antibiotics in the treatment of gonorrhea, certain herbs and minerals may be used to supplement the treatment. These may be used to improve the body's immune function: zinc, multivitamins and mineral complexes, vitamin C, and garlic (Allium sativum). Lactobacillus acidophilus in supplements and live-culture yogurts help replenish gastrointestinal flora that may be destroyed by the intake of antibiotics.

Several herbs may reduce symptoms and help speed healing. These include kelp (Macrocystis pyrifera and related species), Calendula officinalis, myrrh (Commiphora molmol), and Thuja occidentalis. These herbs can be taken by the mouth or used as a douche. The Chinese herb Coptis chinensis, used for damp-heat infections, is helpful in treating the genitourinary tract, especially if pelvic inflammatory disease (PID) develops. An herbalist should be consulted to make recommendations for further complications. Some recommend a three-day cleansing fast to quicken and support healing. Fasting should be done only with the approval and supervision of a physician. Referral to an acupuncturist is also recommended, as there may be acupressure and acupuncture points that will help with system cleansing.

Allopathic Treatment

The typical treatment for gonorrhea is penicillin or a penicillin derivative, given orally or by injection. If the patient is pregnant or allergic to penicillin, erythromycin may be substituted. Gonorrhea has become more difficult and expensive to treat since the 1970s because it has become increasingly resistant to certain antibiotics. In fact, according to projections from the Centers for Disease Control and Prevention, 30% of the strains of gonorrhea were resistant to routine antibiotics in 1994, and resistance has been increasing steadily. Because of this, the doctor may also prescribe probenecid, which will increase the antibiotic activity.

In 2002, the Centers for Disease Control (CDC) updated guidelines concerning antibiotics for treating gonorrhea. Resistance of the infection has increased to certain classes of drugs, particularly when gonorrhea was contracted in certain states, particularly California. Guidelines had already warned against use of these drugs, called fluoroquinolones, in Hawaii, other Pacific islands, and Asia.

Since other STDs, such as chlamydia and syphilis, often occur with gonorrhea, patients may also be tested and treated for these related infections. Patients should refrain from sexual intercourse until treatment is complete and should return for follow-up testing. Anyone the patient has had sexual contact with during the time of infection should be notified and treated, even if those persons do not show symptoms. Doctors are required to report this disease to public health officials.

More than one health care provider may have to be consulted. Physicians trained in obstetrics or gynecology may be involved if gynecological complications occur. Men who experience complications may be referred to a urologist. There are also infectious disease doctors who specialize in the treatment of infectious diseases, including STDs.

Expected Results

The prognosis for patients with gonorrhea varies based on how early the disease is detected and treated. Patients who are treated early and properly can be entirely cured of the disease. The most common complication is PID. PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, an ectopic pregnancy, or sterility. If an infected woman is pregnant, gonorrhea can be passed on to the eyes of the newborn during delivery. This can lead to infection and blindness.

Although the risk of infertility due to gonorrhea is higher in women than in men, men may also become sterile if urethritis (inflammation of the urethra) develops. Complications of gonorrhea can affect the prostate, testicles, and surrounding glands as well. In either gender, inflammation, abscesses, and scarring can occur. In approximately 2% of patients with untreated gonorrhea, the infection may spread throughout the body and can cause fever, arthritis-like joint pain, and skin lesions.

Prevention

Currently, there is no vaccine for gonorrhea. The best prevention is to abstain from having sex, or to engage in sex only when in a mutually monogamous relationship in which both partners have been tested for STDs. The next line of defense against gonorrhea is the use of condoms, which have been shown to be highly effective in preventing disease. The use of a diaphragm can also reduce the risk of infection. Since the risk of contracting gonorrhea increases with the number of sexual partners, those who have sexual contact with more than one partner are advised to be tested regularly for gonorrhea and other STDs.

Resources

Books

Burton Goldberg Group, comp. Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing, 1995.

Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1996.

Segen, Joseph, M.D., and Joseph Stauffer. The Patient's Guide to Medical Tests: Everything You Need to Know About the Tests Your Doctor Prescribes. New York: Facts On File, 1998.

Periodicals

"Gonorrhea Rates Rising Among Hardest Hit: HIV Infection Implications are Ominous." TB Monitor (May 2002):57.

Mahoney, Diana. "STD Guide Urges Rescreening After Chlamydia Therapy: CDC Also Updates Its Recommendations on Gonorrhea, Genital Herpes, and Nonoxydnol-9." Family Practice News (June 15, 2002):1.

Organizations

American Foundation for the Prevention of Venereal Disease, Inc. 799 Broadway, Suite 638, New York, NY 10003. (212) 759-2069.

American Social Health Association. P.O. Box 13827, Research Triangle Park, NC 27709. (919) 361-8400. Fax: (919) 361-8425. http://www.ashastd.org.

National Institute of Allergy and Infectious Diseases, Office of Communications and Public Liaison. Building 31, Room 7A-50, 31 Center Drive MSC 2520, Bethesda, MD 20892-2520. http://www.niaid.nih.gov.

Other

"Gonorrhea." The Merck Manual Online.http://www.merck.com/pubs/mmanual/section13/chapter164/164b.htm.

[Article by: Patience Paradox; Teresa G. Odle]

Gonorrhea is a sexually transmitted disease (STD) caused by Neisseria gonorrhoeae, a bacterium. Gonorrhea is spread through sexual contact (vaginal, oral, or anal). The organism can grow easily in mucous membranes of the body, including the cervix, uterus, and fallopian tubes in women, and the urethra, mouth, throat, and rectum in women and men. It can also invade the conjunctiva (e.g., during childbirth). Each year approximately 650,000 persons in the United States get gonorrhea. Approximately 75 percent of gonorrhea cases are found in persons age fifteen to twenty-nine years. About 50 percent of men have some initial symptoms, typically a burning sensation when urinating and a discharge from the penis. Many infected women are asymptomatic or have only mild symptoms. Initial symptoms include a painful or burning sensation when urinating and a vaginal discharge that is yellow or bloody. Untreated gonorrhea in women can develop into pelvic inflammatory disease (PID), which can cause infertility or increase the future risk of ectopic pregnancy. An infected pregnant woman can transmit the infection to her newborn during vaginal delivery.

N. gonorrhoeae in the male or female genital tract can be diagnosed in a laboratory using a urine specimen. Many of the currently used antibiotics can successfully cure gonorrhea. Persons who engage in sexual behaviors that place them at risk of STDs should use latex or polyurethane condoms every time they have sex, limit the number of sex partners, and not go back and forth between partners. All young, sexually active, nonmonogamous persons who do not use condoms every time they have sex should consider being screened for gonorrhea yearly. Infected persons should notify all sex partners so they can receive treatment.

(SEE ALSO: Sexually Transmitted Diseases)

Bibliography

Centers for Disease Control and Prevention (1998). "1998 Guidelines for Treatment of Sexually Transmitted Diseases." Morbidity and Mortality Weekly Report 47(RR-1):59–70.

Hook, E. W., III, and Handsfield, H. H. (1999). "Gonococcal Infections in the Adult." In Sexually Transmitted Diseases, 3rd edition, eds. K. Holmes, P. Mardh, P. Sparling et al. New York: McGraw-Hill.

— ALLISON L. GREENSPAN; JOEL R. GREENSPAN

For more information on gonorrhea, visit Britannica.com.

An acute and sexually transmitted disease, caused by bacteria that invade the mucous membranes of the genitals and urinary tract. In women, the disease can also spread to the cervix, fallopian tubes, and ovaries, leading to chronic pelvic pain or infertility. In both sexes, the disease can spread to the joints and skin (or, more rarely, the heart or brain) if left untreated. The disease can be treated with antibiotics.

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"The clap" redirects here. For other uses, see Clap.

Gonorrhea
Classification and external resources
ICD-10	A54
ICD-9	098
MeSH	D006069

During WWII, the US government used posters to warn servicemen about the dangers of gonorrhea and other sexually transmitted infections.

Gonorrhea (also gonorrhoea) is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae (also called Gonococcus, which is often abbreviated as "GC" by clinicians). In the US, its incidence is second^[1] only to chlamydia among bacterial STDs.^[2]

The symptoms in males include a yellowish discharge from the penis, which causes painful, frequent urination. Symptoms can develop from two to thirty days after infection. A few percent of infected men have no symptoms. The infection may move into the prostate, seminal vesicles, and epididymis, causing pain and fever. Untreated, gonorrhea can lead to sterility.

Fewer than half the women with gonorrhea show any symptoms, or symptoms mild enough to be ignored. Early symptoms include a discharge from the vagina, some discomfort in the lower abdomen, irritation of the genitals, pain or burning during urination and some abnormal bleeding. Women who leave these symptoms untreated may develop severe complications. The infection will usually spread to the uterus, fallopian tubes, and ovaries, causing Pelvic Inflammatory Disease (PID). It can not be caused by sharing toilets and bathrooms ^[3].

Some early symptoms of this infection are lower abdomen pain, fever, nausea, and pain during intercourse. In both men and women if gonorrhea is left untreated, it may spread throughout the body, affecting joints and even heart valves.

Contents 1 Symptoms 2 Complications 3 Treatment 3.1 Antibiotics 3.2 United States recommendations 3.3 United Kingdom recommendations 3.4 Historically 4 Prevalence 5 References

Symptoms

The incubation period is 2 [1] to 30 days with most symptoms occurring between 4–6 days after being infected. A small number of people may be asymptomatic for a lifetime. Between 30% and 60% of people with gonorrhea are asymptomatic or have subclinical disease.^[4] Women may complain of vaginal discharge, difficulty urinating (dysuria), projectile urination, off-cycle menstrual bleeding, or bleeding after sexual intercourse. The cervix may appear anywhere from normal to the extreme of marked cervical inflammation with pus. Possibility of increased production of male hormones is common in many cases. Infection of the urethra (urethritis) causes little dysuria or pus. The combination of urethritis and cervicitis on examination strongly supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients. Gonorrhea is caused by the Neisseria gonorrhoeae bacteria. The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations, though transmission occurs rarely with safe sex practices of condom usage with lubrication.

Men have a 20% risk of getting the infection from a single act of vaginal intercourse with a woman infected with gonorrhea. Women have a 60-80% risk of getting the infection from a single act of vaginal intercourse with a man infected with gonorrhea.^[5] An infected mother may transmit gonorrhea to her newborn during childbirth, a condition known as ophthalmia neonatorum.^[6]

Less advanced symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever. It is not unusual for men to have asymptomatic gonorrhea. Men may complain of pain on urinating and thick, copious, urethral pus discharge (also known as gleet) is the most common presentation. Examination may show a reddened external urethral meatus. Ascending infection may involve the epididymis, testicles or prostate gland causing symptoms such as scrotal pain or swelling. Instances of blurred vision in one eye may occur in adults.

Gonorrhea infection can also present as septic arthritis.

Complications

In men, inflammation of the epididymis (epididymitis); prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea^[6].

In women, the most common result of untreated gonorrhea is pelvic inflammatory disease, a serious infection of the uterus that can lead to infertility. Other complications include: perihepatitis,^[6] a rare complication associated with Fitz-Hugh-Curtis syndrome; septic arthritis in the fingers, wrists, toes, and ankles; septic abortion; chorioamnionitis during pregnancy; neonatal or adult blindness from conjunctivitis; and infertility. Neonates coming through the birth canal are given erythromycin ointment in eyes to prevent blindness from infection. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.

Treatment

Antibiotics

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Antibiotics that may be used to treat gonorrhea include:

• Amoxicillin 2 g plus probenecid 1 g orally
• Ampicillin 2 to 3 g plus probenecid 1 g orally
• Azithromycin 2 g orally
• Cefixime 400 mg orally^[7]
• Cefotaxime 500 mg by intramuscular injection
• Cefoxitin 2 g by intramuscular injection, plus probenecid 1 g orally
• Cefpodoxime (Vantin) 400 mg orally
• Ceftriaxone (Rocephin) 125 to 250 mg by intramuscular injection
• Ciprofloxacin 500 mg orally
• Levofloxacin 250 mg orally
• Ofloxacin 400 mg orally
• Spectinomycin 2 g by intramuscular injection

The level of tetracycline resistance in Neisseria gonorrhœae is now so high as to make it completely ineffective in most parts of the world.

The fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) cannot be used in pregnancy. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with chlamydia is common, doctors may prescribe a combination of antibiotics, such as ceftriaxone with doxycycline or azithromycin, to treat both diseases.

Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria within the rectum produce β-lactamases that destroy penicillin. All current treatments are less effective at treating gonorrhea of the throat, so the patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive.

Although gonorrhea usually does not require follow-up (with the exception of rectal or pharyngeal disease), patients are usually advised to phone for results five to seven days after diagnosis to confirm that the antibiotic they received was likely to be effective. Patients are advised to abstain from sex during this time.

Drug resistant strains are known to exist.

United States recommendations

The United States does not have a federal system of sexual health clinics, and the majority of infections are treated in family practices. A third-generation cephalosporin antibiotic such as ceftriaxone is recommended for use in most areas.

Since 1993, fluoroquinolones (i.e., ciprofloxacin, ofloxacin, or levofloxacin) have been used frequently in the treatment of gonorrhea because of their high efficacy, ready availability, and convenience as a single-dose, oral therapy. Beginning in 2000, fluoroquinolones were no longer recommended for gonorrhea treatment in persons who acquired their infections in Asia or the Pacific Islands (including Hawaii); in 2002, this recommendation was extended to California (2). In 2004, the Center for Disease Control (CDC) recommended that fluoroquinolones not be used in the United States to treat gonorrhea in men who have sex with men (MSM). On the basis of the most recent evidence, CDC no longer recommends the use of fluoroquinolones for the treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease (PID).^[8] Consequently, the cephalosporins are now the only class of drugs available in the United States still recommended by the CDC for the treatment of uncomplicated gonorrhea.^[9]

Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another sexually transmitted disease, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs. It is important to take all of the medication prescribed to cure gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. If a person's symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated.

United Kingdom recommendations

In the United Kingdom, the majority of patients with gonorrhea are treated in dedicated sexual health clinics. The current recommendation is for ceftriaxone or cefixime as first line therapy; no resistance to either drug has yet been reported in the UK. Levels of spectinomycin resistance in the UK are less than 1%, which would make it a good choice in theory, but intramuscular spectinomycin injection is very painful.

Azithromycin (given as a single dose of 2 g) has been recommended if there is concurrent infection with chlamydia. However, since 2000, the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) has gathered data on drug resistant strains of gonorrhoea in the UK. In 2005, 2.2% of cases were azithromycin resistant and in some regions of the UK this extended to 5% of cases. The mainstay of treatment now is a cephalosporin with azithromycin (to cover chlamydia). A single dose of oral ciprofloxacin 500 mg is effective if the organism is known to be sensitive, but fluoroquinolones were removed from the UK recommendations for empirical therapy in 2003 because of increasing resistance rates. In 2005, resistance rates for ciprofloxacin were 22% for the whole of the UK (42% for London, 10% for the rest of the UK).^[10]

Historically

An old patent medicine named "Gono" pitches itself as "Man's Friend for gonorrhea and gleet - an unequalled remedy for unnatural discharges".

Historically it has been suggested that mercury was used as a treatment for gonorrhea. Surgeons tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into any unfortunate crewman suffering from gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century.^[11]

Silver nitrate was one of the widely used drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün invented this type of colloidal silver which was marketed by Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.^[12][13]

Penicillin entered mass production in 1944 and revolutionized the treatment of several venereal diseases.

The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occur in the Acts of the (English) Parliament, In 1161 this body passed a law to reduce the spread of "...the perilous infirmity of burning."^[14] The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX in France in 1256, replacing regulation with banishment. ^[15] Similar symptoms were noted at the siege of Acre by Crusaders.

Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired public health doctors to treat afflicted patients without right of refusal. Pope Boniface rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.

Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic victims.^[16] After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted disease.

Prevalence

"Gonorrhea is a very common infectious disease. The CDC estimates that more than 700,000 people in the United States get new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2004, 330,132 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113.5 per 100,000 persons."^[17]

References

1. ^ "CDC - STD Surveillance - Gonorrhea". http://www.cdc.gov/std/stats/gonorrhea.htm. Retrieved 2008-08-21. 
2. ^ "CDC Fact Sheet - Chlamydia". http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm. Retrieved 2008-08-21. 
3. ^ "webmd - What Can You Catch in Restrooms? -". http://www.webmd.com/balance/features/what-can-you-catch-in-restrooms. 
4. ^ YT van Duynhoven (1999). "The epidemiology of Neisseria gonorrheae in Europe". Microbes and Infection 1 (6): 455–464. doi:10.1016/S1286-4579(99)80049-5. PMID 10602678. 
5. ^ ^ National Institute of Allergy and Infectious Diseases; National Institutes of Health, Department of Health and Human Services (2001-07-20). "Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention" . Hyatt Dulles Airport, Herndon, Virginia. pp14
6. ^ ^{a b c} Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 705-706 ISBN 978-1-4160-2973-1
7. ^ http://cme.medscape.com/viewarticle/555228
8. ^ "CDC Update to Sexually Transmitted Treatment Guidelines". http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm?s_cid=mm5614a3_e. Retrieved 2008-08-21. 
9. ^ "CDC STD Treatment Regimens". http://www.cdc.gov/std/treatment/2006/updated-regimens.htm. Retrieved 2008-08-21. 
10. ^ Health Protection Agency. "The gonococcal resistance to antimicrobials surveillance programme: Annual report 2005" (PDF). http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/sti-gonorrhea/publications/GRASP_2005_Annual_Report.pdf. Retrieved 2006-10-28. 
11. ^ Oxford English Dictionary
12. ^ Max Bender (1898). "Ueber neuere Antigonorrhoica (insbes. Argonin und Protargol)". Archives of Dermatological Research 43 (1): 31–36. doi:10.1007/BF01986890. 
13. ^ "MedlinePlus - Neonatal Conjunctivitis". http://www.nlm.nih.gov/medlineplus/ency/article/001606.htm. Retrieved 2008-08-28. 
14. ^ W Sanger. History of Prostitution. NY,Harper, 1910 .
15. ^ P. LaCroix. The History of Prostitution—Vol. 2. NY,MacMillan, 1931.
16. ^ WE Leiky. History of European Morals. NY, MacMillan, 1926.
17. ^ "Gonorrhea - CDC Fact Sheet". http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm. Retrieved 2008-07-31. 

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Dansk (Danish)
n. - gonorre

Nederlands (Dutch)
gonorroe

Français (French)
n. - blennorragie

Deutsch (German)
n. - Gonorrhöe, Tripper

Ελληνική (Greek)
n. - γονόρροια, βλενόρροια

Italiano (Italian)
gonorrea

Português (Portuguese)
n. - gonorréia (f) (Med.)

Русский (Russian)
гонорея

Español (Spanish)
n. - gonorrea

Svenska (Swedish)
n. - gonorré

中文（简体）(Chinese (Simplified))
淋病

中文（繁體）(Chinese (Traditional))
n. - 淋病

한국어 (Korean)
n. - (병) 임질

日本語 (Japanese)
n. - 淋病

العربيه (Arabic)
‏(الاسم) مرض جنسي, السيلان‏

עברית (Hebrew)
n. - ‮זיבה‬

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